In the span of 18 months after being diagnosed with a recurrence of ovarian cancer, Francine Milano found herself making a journey that she never expected. Having already battled the disease 20 years ago, the news of its return left her with a difficult decision to make. Despite residing in Pennsylvania, she felt compelled to travel to Vermont, not for leisure but to arrange for her own passing.
“I felt the need to take control of my final moments,” shared the 61-year-old resident of Lancaster. “I made the conscious choice that this was the path for me.”
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When Milano received the devastating news in early 2023 that her cancer was terminal, she discovered that medical assistance in dying was not an option within her home state. At that point, her only choices would be to go to Switzerland or reside in the District of Columbia or one of the 10 states with legal aid in dying, including New Jersey.
Fortunately, Vermont lifted its residency requirement in May 2023, followed shortly by Oregon. Although Montana permits aid in dying through a 2009 court ruling, specifics regarding residency remain unclear. While New York and California have explored legislation to extend this privilege to non-residents, none have yet been successful.
Despite the logistical challenges, such as locating new doctors, determining end-of-life arrangements, and navigating travel while severely ill, many individuals have made the trek to Vermont and Oregon to access aid in dying.
According to data from the Vermont Department of Health, at least 26 individuals traveled to Vermont to peacefully end their lives from May 2023 to June of the following year. Over in Oregon, 23 non-residents sought medical assistance to end their suffering in 2023, accounting for just over 6% of the state’s overall total.
Oncologist Charles Blanke, whose practice specializes in end-of-life care in Portland, mentioned that Oregon’s figures may be underreported, and he anticipates a rise in out-of-state patients seeking these services. Over the past year, he has seen an average of two to four non-resident patients per week, amounting to approximately one-quarter of his practice.
Nevertheless, the legal framework governing aid in dying is stringent. In states like Oregon and Vermont, patients must undergo evaluation by two physicians, have a life expectancy of less than six months, demonstrate mental and cognitive soundness, and possess the capacity to ingest the prescribed medication on their own.
State legislatures have implemented these protocols as protective measures to respect the rights of individuals considering aid in dying while upholding ethical standards within the medical community. However, advocates argue that these regulations pose added challenges and burdens for patients facing terminal illnesses.
Diana Barnard, a palliative care physician from Vermont, noted that some patients struggle to keep appointments due to deteriorating health. The logistics involved in traveling to another state for end-of-life arrangements can be physically and emotionally draining, depriving patients of precious time with loved ones.
Opposition to aid in dying comes from various quarters, including religious groups condemning the act as immoral and healthcare professionals emphasizing the importance of providing comfort to patients near the end of life rather than facilitating their passing.
Anthropologist Anita Hannig, author of “The Day I Die: The Untold Story of Assisted Dying in America,” believes that federal legislation on the matter is unlikely anytime soon. Much like abortion, the Supreme Court declared assisted dying a states’ rights issue back in 1997.
In the recent legislative sessions of 2023-24, 19 states deliberated on aid-in-dying laws, with only Delaware successfully enacting such legislation pending the governor’s approval. Peg Sandeen from Compassion & Choices remained hopeful that states would eventually follow Vermont and Oregon’s lead, even as restrictive provisions are revisited and amended over time.
Milano expressed a preference for New Jersey as a more accessible option due to its earlier legalization of aid in dying. However, residency requirements posed a setback. Ultimately, she embarked on a nine-hour journey to Vermont, choosing the path of least resistance both financially and physically.
For Milano, the logistics were crucial as she navigated the challenges of returning to Vermont when the time came. Upon her second visit in June, accompanied by a friend in a camper van, she opted for a virtual medical consultation instead of traveling to Burlington in person.
Reflecting on her journey, Milano acknowledged the uncertainties that lie ahead. Despite her gratitude for having the option to determine her fate while still in control of her faculties, she empathized with those who yearn for the same choice.
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